Stepwise Fenestration via Natural Orifice Transluminal Endoscopic Surgery for Symptomatic Polycystic Liver Disease

A 60-year-old woman was referred to our hospital with a 2-year history of progressive abdominal distention. Physical examination showed a palpable enlarged liver and mild tenderness in the right upper quadrant. Computed tomography showed countless fluid-filled cysts of various sizes throughout the entire liver (Figure A), consistent with a diagnosis of Gigot type III polycystic liver disease (PLD). After informed consent, fenestration by means of a transrectal natural orifice transluminal endoscopic surgery (NOTES) procedure was proposed (Video).